Provider Demographics
NPI:1790957371
Name:JOHNSON, SCOTT E (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 INDEX RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3117
Mailing Address - Country:US
Mailing Address - Phone:608-229-7979
Mailing Address - Fax:608-229-8110
Practice Address - Street 1:2844 INDEX RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53713-3117
Practice Address - Country:US
Practice Address - Phone:608-229-7979
Practice Address - Fax:608-229-8110
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0057837207RP1001X, 207RS0012X
WI55653-020207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029308OtherKAISER COMMERCIAL NUMBER
WI61333OtherDEAN HEALTH INSURANCE